The Canadian Community Health Survey

Canadian Community Health Survey Nova Scotia s Health Care System: Use, Access, and Satisfaction February 2005 Cycle 2.1 Report 3 The Canadian Community Health Survey (CCHS) is a new series of health surveys being conducted by Statistics Canada. Its purpose is to provide regular and timely cross-sectional estimates of health determinants, health status, and health system utilization for 133 health regions across the country. Data from the second installment of the CCHS (Cycle 2.1) was collected between January and December 2003 and was released in June 2004. This report, the third in a series from CCHS Cycle 2.1, examines the use of physicians and other health providers in Nova Scotia and the quality and satisfaction ratings of the health delivery sectors. It also takes a look at those who felt they needed but did not receive it. Highlights Approximately 9% of Nova Scotians, aged 12 and over, reported having stayed overnight in a hospital or nursing/convalescent home in the past 12 months. Those in the older age groups, those in the lower income groups and women were more likely to report overnight stays. The health professional most consulted by Nova Scotians is the family physician, followed by dentist/orthodontist, eye specialist, other medical doctor, physiotherapist, and nurse. Nearly 85% of Nova Scotians reported having visited a family physician at least once in the past 12 months. 38% of Nova Scotians had no contact with a dentist/orthodontist and had no contact with an eye specialist in the past 12 months. Nearly 3 of Nova Scotians reported having visited other medical doctors (such as surgeons, allergists, orthopedists, gynaecologists, or psychiatrists) in the past 12 months. Approximately 8% of Nova Scotians reported having had a nursing visit in the past 12 months, and the visits most frequently occurred at an outpatient clinic or at home. Health

Nova Scotians were very satisfied with the health services they received, including physician, community-based, and hospital. Approximately 11% of Nova Scotians reported that there was a time in the past 12 months when they felt they needed health but didn t receive it. Among Nova Scotians who felt they needed but did not receive it, physical problem was the leading health problem for which was not received, and wait time too long was the leading reason why was not received. Those in the -age groups, those in the lower income groups, those who self-reported poorer health status, and women were more likely to report not receiving when they felt they needed it. Overnight stays About nine percent (8.8%) of Nova Scotians reported having been an overnight patient in a hospital, nursing home or convalescent home in the past 12 months. This figure is slightly lower than the CCHS 1.1 report (1). Among these overnight stays, 7 were for seven nights or less, and 8% were for 14 nights or less. A considerable proportion (12.%) of Nova Scotians reported having been a patient in a hospital, nursing home or convalescent home for over 14 nights (Figure 1). Women are significantly more likely than men to report overnight stays. Ten percent of women reported having been an overnight patient in the past 12 months compared to seven percent of men. The likelihood of reporting overnight stay also increases with age (Figure 2). Fifteen percent of Nova Scotians in the 5+ age group reported having stayed in a hospital, nursing home or convalescent home in the past 12 months, significantly higher than the 12-24 age group and the 25-4 age group. FIGURE 1 Number of nights stayed in a hospital, nursing or convalescent home in the past 12 months, 2 1% 1 8% 1% 1 1 1 8% % 18.8 1 12.8 13.1 12.8 12.3 12. 2 3 4.8 5 Number of nights 2 7.2 7 8 14 Over 14 FIGURE 2 Percent of respondents who have stayed in a hospital, nursing or convalescent home in the past 12 months, 5.8 12 24 8.3 25 4 Age group * Significantly higher than 12 24, 25 4 age group. 15* 5+ 2 Nova Scotia s Health Care System Nova Scotia Department of Health CCHS Cycle 2.1 Report 3

It is important to note that no distinction was made between these types of facilities in the survey. Since nursing home or convalescent home stays can be long, this may overestimate the length of overnight stays in hospitals. The percentage of respondents who reported overnight stays varies across DHAs. It ranges from a low of.8% in DHA 9 to a high of 12.9% in DHA 5 (Figure 3). FIGURE 3 Percent of respondents who have stayed overnight in a hospital, nursing or convalescent home in the past 12 months by DHA, 1 1 1 8% % 7.4 1 10.2 2 9. 3 10.3 Who sees health professionals? 4 12.9 The most consulted health professional in Nova Scotia is the family physician. Nearly 85% of Nova Scotians reported having visited a family physician at least once in the past 12 months. Other most consulted health professionals include dentist/orthodontist (1.8%), eye specialist (37.5%), other medical doctor (28.3%), physiotherapist (8.5%), and nurse (7.8%) (Figure 4). 5 District Health Authority (DHA) * Significantly different from DHA 8. 10.2 9.7 7 11.9 8.8* 9 FIGURE 4 Percent of respondents who had at least one contact with health professionals, 10 9 8 7 5 4 3 2 1 84.3 Family Doctor/ general practioner 1.8 Dentist/ orthodontist 37.5 Eye specialist Family physician 28.3 Other medical doctor* Physiotherapist Health professional Nurse * Such as surgeon, allergist, orthopedist, gynaecologist, or psychiatrist. About sixteen percent (15.7%) of Nova Scotians had no contact with a family physician in the past 12 months, and the rest (84.3%) reported having visited a family physician at least once in the past 12 months (Figure 5). The percentage of Nova Scotians who reported family physician visit is slightly higher than the CCHS 1.1 report (81%). About forty percent of Nova Scotians reported having visited a family physician once or twice, and about twenty percent reported having visited a family physician three or four times. A substantial proportion (11.8%) of Nova Scotians reported having seen a family physician for 10 or more times. Most of these contacts (89.9%) occurred at the doctor s office, and over 5 percent (5.5%) occurred at an outpatient clinic or an appointment clinic. Women are more likely than men to report family physician visits. About ninety percent of women (89.5%) reported having visited a family physician at least once in the past 12 months, significantly higher than the reported rate of family physician visit among men (78.). 8.5 7.8 CCHS Cycle 2.1 Report 3 Nova Scotia Department of Health Nova Scotia s Health Care System 3

The likelihood of family physician visits among Nova Scotians increases with age (Figure ). In the past 12 months, 91. of those aged 5 years or older and 88.3% of those aged 45-4 years old reported having visited a family physician, both these age groups were significantly higher than the younger age groups (82.8% for the 25-44 age group, and 74.3% for the 12-24 age group). This may be a reflection of the fact that health declines with age. FIGURE 5 Number of visits with a family physician in the past 12 months, 25% 2 15% 1 5% FIGURE Percent of respondents with at least one family physician visit in the past year by age group, 10 8 4 2 20.7 1 18.2 2 74.3 12 24 10.2 3 10.3 4 82.8 25 44 3.7 5 Number of visits Age group 0.8 1.9 0. 7 8 9 88.3* 45 4 91.2* 5+ 11.8 10+ Nova Scotians with higher education levels are also more likely to report family physician visit (Figure 7). Among Nova Scotians who have postsecondary education, 8.7% reported having visited a family doctor at least once in the past 12 months, significantly higher than those with less than secondary education (81.7%). FIGURE 7 Percent of respondents with at least one family physician visit in the past 12 months by education level, 10 8 4 2 81.7 less than secondary 80.5 Secondary graduation Some post secondary * Significantly higher than "less than secondary". 8.7* Post secondary graduation Nova Scotians with different income levels were equally likely to report physician visit. This is believed to be a reflection of the widely accessible publicly funded health system in Nova Scotia. Nova Scotians who reported poorer health status also reported higher levels of physician visit compared to those who reported better health status (Figure 8). Overall, 95. of those who rated themselves as having poor health and 93.7% of those who rated themselves as having fair health also reported having visited a family physician in the past 12 months. Both of these figures are significantly higher than those who rated their health status to be good (84.), very good (82.), and excellent (79.). 83 Education Level * Significantly higher than 12 24 and 25 44 age groups. 4 Nova Scotia s Health Care System Nova Scotia Department of Health CCHS Cycle 2.1 Report 3

FIGURE 8 Percent of respondents with at least one family physician visit in the past 12 months by self-reported health status, FIGURE 9 Percent of respondents with at least two dental visits in the past 12 months by income level, 10 8 95.2* 93.7* 84.4 82.4 79.4 35% 28% 31.7* 31.8* 21% 4 1 14.4* 2 Poor Fair Good Very good Excellant Self-reported health status * Significantly higher than "good", "very good", and "excellant". 7% 1.4 Lowest 3.5 Lower Middle Income quintile Upper * Significantly higher than lowest and lower. Highest Dentist/orthodontist The Canadian Dental Association suggests a regular dental check-up every six months 1. However, the frequency of dental visit among Nova Scotians is far below this recommended rate. The survey reveals that, in the past 12 months, only 1.8% of Nova Scotians have visited a dentist or orthodontist (increased from 57% in the CCHS 1.1), which suggests that over one third of Nova Scotians did not have a dental check-up in the past year. Only 35.1% of Nova Scotians have visited a dentist or orthodontist twice or more in the past year. Since dental is not publicly funded, family income is an important determinant of the frequency of dental visit. Significantly larger proportions of those in the higher income quintiles reported having had at least two dental visits in the past year than those in the lower income quintiles (Figure 9). Eye specialist Vision and ocular health conditions are not always accompanied by recognizable symptoms, and therefore it is recommended that the minimum frequency of eye examination is every one to two years 2. However, only 37.5% of Nova Scotians reported having visited an eye specialist (ophthalmologist or optometrist) at least once in the past 12 months (unchanged from CCHS 1.1), suggesting that Nova Scotians are not having their eyes checked as frequently as recommended. This under-utilization of eye specialists in Nova Scotia may be partly due to the fact that not all such visits are publicly funded. Overall, 31. of those in the upper- income quintile and 21.9% of those in the highest income quintile also reported having contacted an eye specialist in the past year, compared to only 2. of those in the lowest income quintile and. of those in the lower- income quintile (Figure 10). CCHS Cycle 2.1 Report 3 Nova Scotia Department of Health Nova Scotia s Health Care System 5

FIGURE 10 Percent of respondents with at least one eye specialist visit in the past 12 months by income level, 35% 28% 21% 1 7% 2.2 Lowest Lower 17.9* Middle Income quintile Other medical doctor 31.2* Upper * Significantly higher than lowest and lower. 21.9* Highest Other medical doctors include doctors such as surgeons, allergists, orthopedists, gynaecologists, or psychiatrists. In the past 12 months, 28.3% of Nova Scotians reported having consulted any of these medical doctors about their physical, emotional or mental health. Contacts with these medical doctors most frequently occurred at a doctor s office (54.5%), a hospital outpatient clinic (29.), and an appointment clinic (8.%). Other health professionals Table 1 shows the use of several other health- professionals, including alternative health- providers, chiropractor, social worker/counselor, psychologist, and speech pathologists/audiologist/ occupational therapist. Table 1 Percentage of Nova Scotians Accessing Other Health- Professionals (CCHS 2.1) Health- Care Professional Alternative health- providers* Estimated Percentage Accessing 7.7% Chiropractor 3.8% Social worker/counsellor 3.8% Psychologist 2.7% Speech/audiologist/ occupational therapist 1.5% * The category alternative health- provider includes such services/providers as massage therapist, acupuncturist, homeopath or naturopath, Feldenkrais or Alexander teacher, relaxation therapist, biofeedback teacher, rolfer, herbalist, reflexologist, spiritual/religious healer, and others. Physiotherapist/Nurse In the past 12 months, 8.5% of Nova Scotians reported having consulted a physiotherapist and 7.8% reported having consulted a nurse. Contacts with a nurse most frequently occurred at an outpatient clinic (28.7%), a home (17.), an emergency room (12.), and a doctor s office (8.%). Nova Scotia s Health Care System Nova Scotia Department of Health CCHS Cycle 2.1 Report 3

How is the health system rated? Overall, Nova Scotians are very pleased with the quality of the health they receive. Among those who received in the past 12 months, 87.9% rated the quality of health as good or excellent (up from 85% in CCHS 1.1). Among the types of received, Nova Scotians were most satisfied with physician (93.1% rated this as good or excellent), followed by community-based (90. rated this as good or excellent) and hospital (87.1% rated this as good or excellent) (Figure 11). FIGURE 11 Quality ratings of health services in 7 5 4 3 2 1 4.1 41.8 9.7 Excellant 2.5 Overall health services 51.3 35.8 Hospital Rating of quality Good Physician Community-based Fair * Significantly higher than hospital and community-based. ** Significantly lower than hosptial. Poor Nova Scotians are also very satisfied with the way health services were provided. Among those who received in the past 12 months, 85.8% were very satisfied or somewhat satisfied with the way health services were provided (up slightly from 8 in the CCHS 1.1). The satisfaction level with physician was again the highest (94. were very satisfied or somewhat satisfied) among various types of received, followed by community-based (85.8% were very satisfied or somewhat satisfied) and hospital (82.7% were very satisfied or somewhat satisfied) (Figure 12). 4* 29.1 49.2 41.2.5.5 5.4 1.4** 5 4.7 FIGURE 12 Satisfaction with health services in 10 9 8 7 5 4 3 2 1 85.8 2.5 11.7 Overall health services Very/somewhat satisfied 82.7 2.5 14.8 Hospital 94.2* Physician Rating of Satisfaction Neither satisfied or dissatisfied 0.9 4.9 ** 85..8 # Community-based Who is not receiving? 10.7 Very/somewhat dissatisfied * Significantly higher than hospital and community-based. ** Significantly lower than hosptial. # Estimate could not be reported according to Statistics Canada guidelines (See Appendix 1) Overall, about 10.5% of Nova Scotians reported that there was a time in the past 12 months when they felt they needed health but didn t receive it (compared to 1 in the CCHS 1.1). This rate is slightly lower than the rate for Canada (11.), and Manitoba (11.9%), a province of similar population. Among the Atlantic provinces, it is higher than Prince Edward Island (8.5%), but lower than New Brunswick (11.5%) and Newfoundland (11.1%). Across the DHAs, DHA 9 reported the lowest percentage of those who felt was needed but not received (7.9%), which was significantly lower than DHA 3 (13.%), DHA (14.5%), and DHA 8 (15%) (Figure 13). Among those who felt they had an unmet health need, physical problem was the most commonly reported type of health problem for which was not received (71.%). Other reported categories include of an injury (9.5%), emotional or mental health problem (8.8%), and regular check-up (8.1%) (Figure 14). CCHS Cycle 2.1 Report 3 Nova Scotia Department of Health Nova Scotia s Health Care System 7

FIGURE 13 Percent of respondents who "felt was needed but not received" by DHA, 1% 1 8% 11.4 1 10.2 2 13. 3 10 4 14 5 DHA 14.5 * Significantly lower than DHA 3,, and 8. 8.7 7 15 8 NS 10.5% 7.9* FIGURE 14 Type of not received among those who felt they had an unmet health need, Nova Scotia (CCHS 2.1) 8 7 5 4 3 2 1 71.* Physical health problem 9.5 Injury 8.8 Emotional/mental Regular health problem chekup Type of Care * Significantly higher than other types. 8.1 7 Other 9 The reasons cited for not receiving when it was felt needed can be split into two categories: those related to the health system and those that are more personal factors. Wait time was the leading system related reason cited. Among Nova Scotians who felt they had an unmet health need, 38. reported that long waiting time was the reason why they did not receive the they felt they needed. Wait times are an important issue to Nova Scotians. The Department of Health has made this issue a priority and is currently working on ways to address this, as outlined in the document Your Health Matters: Working Together Toward Better Care. 3 Besides long wait times, other system related reasons include not available at time required (1.), not available in the area (7.9%), doctor didn t think it was necessary (5.9%). Personal factors cited include cost too much (13.), decided not to seek (12.1%), didn t get around to it or didn t bother (9.), too busy (7.9%), felt it would be inadequate (.9%), dislikes or afraid doctors (2.%), and unable to leave the house because of health problem (1.) (Figure 15). FIGURE 15 Reasons cited for not received among those who felt they had an unmet health need, 5 4 3 2 1 38.2* A 1.4 13.4 B C 12.1 D 9.4 E 7.9 F 7.9.9 5.9 2. G H I J 1.4 K A Waiting time too long (*Significantly higher than other reasons) B Care not available at time required (e.g., doctor on holidays, inconvenient hours) C Cost too much D Decided not to seek E Didn't get around to it/didn't bother F Care not available in the area G Too busy H Felt would be inadequate I Doctor didn't think it necessary J Dislikes doctors/afraid K Unable to leave house because of health problem 8 Nova Scotia s Health Care System Nova Scotia Department of Health CCHS Cycle 2.1 Report 3

Women are more likely to report an unmet health need than men (11. versus 9.7%). Middleaged Nova Scotians are more likely to report an unmet health need than youth and seniors. A higher proportion (1) of those in the age groups (25-44 years and 45-4 years) reported not receiving when they felt it was needed compared to those in the 12-24 age group (8.) and those in the 5+ age group (.7%) (Figure 1). This may be a reflection of the fact that aged people are more likely to be busy with their family- and work-related responsibilities and are more likely to have less opportunities to seek health. Conversely, those in younger or older age groups may have more time to seek. Moreover, youth may experience less unmet health need because of parental involvement. FIGURE 1 Percent of respondents who felt was needed but not received by age group, 1 1 1 8% % 8.2 12 24 11.8* 25 44 Age Group 11.9* 45 4 * Significantly higher than 5+ age group..7 5+ The likelihood of reporting an unmet health need decreases with increasing income (Figure 17). Over thirty percent (30.) of those in the lowest income quintile and 17.7% in the lower income quintile reported not receiving when they felt it was needed, which was significantly higher than those in the upper income quintile (8.3%) and those in the highest income quintile (8.). Nova Scotians with poorer health status are more likely to also report an unmet health need (Figure 18). Among those who consider their health status to be poor or fair, 27.9% and 18. respectively also reported not receiving when it was felt needed. These rates are both significantly higher than those who consider their health status to be very good (8.1%) and excellent (5.1%). FIGURE 17 Percent of respondents who felt was needed but not received by income level, 35% 28% 21% 1 7% 30.4* Lowest 17.7** Lower 12.1 Middle Income quintile Upper Highest * Significantly higher than "", "upper ", and "highest". ** Significantly higher than "upper ", and "highest". Viewed in light of the previous finding where those with the poorer health status were more likely to report a physician visit, this result may seem contradictory. It may be a reflection that those who seek more often are also more likely to report not receiving when they felt they needed it. This result can also be explained, in part, by the finding under income, where people in lower income groups are more likely to also report not receiving when needed. Unlike physician visit, some types of, such as dental, nursing, and physiotherapy, are not publicly funded and therefore must be purchased out of pocket when needed. This may provide an explanation that although people with poorer 8.3 8.4 CCHS Cycle 2.1 Report 3 Nova Scotia Department of Health Nova Scotia s Health Care System 9

health status are more likely to visit physicians, they are also more likely not to receive certain types of that are not publicly funded, especially for those with lower incomes. FIGURE 18 Percent of respondents who felt was needed but not received by self-reported health status, 3 25% 2 15% 1 5% 27.9* Poor 18.4** Fair Home Care 12.5 Good Very good Excellent Self-reported health status * Significantly higher than "good", "very good", and "excellent". ** Significantly higher than "very good" and "excellent". Among Nova Scotians aged 18 years or older, about 3% reported having received any home services in the past 12 months, with the cost being entirely or partially covered by government. Significantly more women than men reported having received government-covered home services (3.7% versus 2.1%). Among those aged 5 years or older, 11.1% reported having received government-covered home, which was significantly higher than the 18-4 age group (1.3%). Nova Scotians in lower income groups were significantly more likely to report receiving government-covered home services, compared to those in higher income groups (Figure 19). About 9% of those from the lowest income group and another 9% from the lower income group reported receiving home 8.1 5.1 services, while only from the income group and from the upper income group reported receiving home services (estimate could not be reported for the highest income group according to Statistics Canada guidelines). FIGURE 19 Percent of respondents who have received government-covered home services in the past 12 months by income quintile, 1 8% % 8.5* Lowest 8.9** Lower Middle Income quintile Upper # Highest * Significantly higher than upper. ** Significantly higher than and upper. # Estimate could not be reported according to Statistics Canada guidelines (See Appendix 1) Note: This question was asked of Nova Scotians aged 18 years or older. The rate of respondents who reported having received government-covered home services in the past 12 months varied across DHAs. DHA 7 reported the highest rate at 5., followed by DHA 8 at 4.%. DHA 9 reported the lowest rate at 2.1% (Figure 20). Among the types of home services received, housework was the most reported type (53.5%), followed by nursing (44.8%), personal (24.), and meal preparation or delivery (14.5%). Only 9.3% reported receiving respite and 5.1% reported receiving shopping services (Figure 21). 3. 1.7 10 Nova Scotia s Health Care System Nova Scotia Department of Health CCHS Cycle 2.1 Report 3

FIGURE 20 Percent of respondents who have received government-covered home services in the past 12 months by DHA, % 5% 3% 1% # 1 3. 2 3 3 2.2 4 # 5 DHA # Estimates could not be reported according to Statistics Canada guidelines (See Appendix 1). FIGURE 21 Type of home services received, 5 4 3 2 1 53.5 Housework 44.8 Nursing 24.4 Personal # 14.5 Meal preparation/ delivery 5 7 9.3 Respite Type of home services 4. 8 5.1 2.1 9 Shopping Among Nova Scotians aged 18 years or older, 1.5% reported that there was a time in the past 12 months that they felt they needed home services but did not receive them. Significantly more women than men reported having experienced unmet home needs (2.1% versus 0.8%). The likelihood of reporting unmet home needs also increases with age (3. for the 5+ age group, 1.% for the 45-4 age group, and 0.8% for the 18-44 age group) (Figure 22). FIGURE 22 Percent of respondents who felt they needed home services but did not receive them by age group, 3% 1% 0.8 18 44 45 4 Age group 5+ Self-perceived unmet home needs were significantly more prevalent among people with lower incomes. Among Nova Scotians in the lowest/lower- income group, 4. reported unmet home needs. This rate was significantly higher than the highest/upper- income group (0.7%) (Figure 23). 1. * Significantly higher than 18 44 age group. 3.4* CCHS Cycle 2.1 Report 3 Nova Scotia Department of Health Nova Scotia s Health Care System 11

FIGURE 23 Percent of respondents who reported self-perceived unmet home needs by income quintile, 5% 3% 1% 4.2* Lowest/lower 2.* Middle Income quintile Income quintile * Significantly higher than upper /highest. Additional Resources 0.7 Upper /highest This document was prepared by the Information Analysis and Reporting, Information Management Branch of the Nova Scotia Department of Health. For additional information on the data included in this report, please contact us at (902) 424-8291. Copies of this report are available on line at <http://www.gov.ns.ca/health/reports.htm>. Click on Canadian Community Health Survey (CCHS) for copies of this and other reports in the series. References 1. Your oral health Visiting the dentist: The Check-up. Canadian Dental Association. Retrieved December 31, 2004 from: http://www.cda-adc.ca/ english/your_oral_health/visiting_dentist/checkup.asp 2. Exam frequency Regular Eye Examinations. The Canadian Association of Optometrists. Retrieved December 31, 2004 from: http://www.opto.ca/en/ public/04_eye_info/04_01_exam_frequency.asp 3. Your Health Matters: Working Together Toward Better Care. Nova Scotia Department of Health, 2003. http://www.gov.ns.ca/health/downloads/ your_health_matters.pdf Appendix I Statistics Canada Guidelines For Reporting of Estimates Based on Coefficient of Variation. Bootstrapping techniques were used to produce the point estimate, the coefficient of variation (CV), and 95% confidence intervals (CIs). The CV s and CI s were used to decide if a point estimate could be reported. Data with a coefficient of variation (CV) from 1.% to 33.3% should be interpreted with caution. Data with a coefficient of variation (CV) greater than 33.3% were suppressed due to extreme sampling variability. 12 Nova Scotia s Health Care System Nova Scotia Department of Health CCHS Cycle 2.1 Report 3